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Editor,—A 14 week old boy was referred for neurological review with a 24 hour history of an isolated, left sided, lower motor neuron facial nerve palsy. Twelve days earlier, he had presented with fever, irritability, and a macular rash. A septic screen was negative, including normal cerebrospinal fluid indices. The fever settled on day 5, the rash improved, and he was discharged. He remained irritable, re-presenting when facial asymmetry developed.
Computed tomography and magnetic resonance imaging of his brain were normal. Initial haematology was unremarkable. Over the next five days he remained afebrile. His facial palsy resolved, but there was an increase in acute phase reactants and an evolving thrombocytosis. On day 17 of the illness, desquamation of the toes was noted. Echocardiography showing aneurysms of the left anterior descending and circumflex coronary arteries confirmed the diagnosis of Kawasaki disease.
Neurological complications of Kawasaki disease are well recognised. Hemiplegia, epilepsy, and myositis have been reported.1 In one large series, neurological complications arose in 1.1% of cases.2 There have been 18 previously reported cases of facial nerve palsy in Kawasaki disease.3 A review of these cases3 noted that six of the 10 children in whom cerebrospinal fluid was sampled had a pleocytosis. At diagnosis, coronary artery involvement was found in 55%, compared to 20–40% of all cases of Kawasaki disease.4
This is the first case reported in the UK presenting with this complication of Kawasaki disease. He presented at an early age; the peak incidence of Kawasaki disease is 9–11 months4 and only one of the reported cases of facial palsy arose in a child younger than 6 months.3 Kawasaki disease should be considered when an acquired facial palsy occurs as an isolated neurological finding in an infant, particularly where fever has occurred in the previous month.